Obesity management from a public health perspective: the effectiveness of national fitness policies, healthy life expectancy, and body center of gravity correction

Obesity has become a globally recognized disease. The prevalent insulin resistance and glucose-lipid metabolism disorders in obese patients make them highly susceptible to chronic cardiovascular, metabolic, endocrine, and immune system diseases. Surveys show that although economic improvements have increased average life expectancy, obesity and its complications, if left untreated, will severely shorten healthy lifespan. The premature deaths of many young and middle-aged people due to obesity have raised significant concerns. Even in adolescence, obesity carries a serious tendency towards metabolic syndrome. Therefore, obesity must adhere to the principle of "early detection, early diagnosis, and early treatment."

The Chinese government foresaw the potential obesity crisis that might result from economic improvement. The "National Fitness Program Implementation Outline" and subsequent regulations, promulgated in 1995, involved government investment in building public fitness facilities and promoting scientific fitness knowledge. This national initiative played a crucial role in combating the rapid rise in obesity rates. The implementation of national fitness activities has significantly reduced the incidence of chronic diseases. As long as the public possesses scientific knowledge of obesity prevention and treatment, the upward trend in obesity can be effectively curbed.

Obese individuals often experience lower back pain, which is not only a muscle problem but also a biomechanical issue. In a normal upright posture, the center of gravity is located at the front of the spine. In obese individuals, especially those with abdominal obesity, the accumulation of abdominal fat shifts the center of gravity significantly forward. To maintain balance and prevent leaning forward, the back muscles must continuously exert increased tension. Prolonged exposure to this tension and contraction leads to muscle fatigue. The fundamental solution to this symptom is effective weight loss, restoring the center of gravity to a normal position. Simultaneously, strengthening the back muscles under a coach's guidance (such as prone sit-ups) can significantly improve symptoms.

Participating in physical fitness activities is beneficial to health, but improper exercise can be counterproductive. Exercise-induced sudden death often occurs in people with underlying medical conditions (such as coronary heart disease or sequelae of myocarditis). From a sports medicine perspective, the person primarily responsible for sudden death is often the individual themselves. Some fitness enthusiasts who have never seen a doctor, believing themselves to be healthy, blindly participate in high-intensity exercise, thus becoming high-risk individuals. Scientific fitness requires each participant to first understand their own health condition and obtain an "exercise prescription" developed by a professional.

The core of exercise prescription design is exercise risk assessment. This includes physical examination, electrocardiogram (ECG), and most importantly, a progressive stress test. A normal ECG at rest does not necessarily mean that the heart is functioning perfectly. Coronary artery stenosis may be asymptomatic at rest, but when exercise intensity increases and myocardial oxygen consumption increases, the imbalance between supply and demand can induce myocardial ischemia. This assessment can determine the safe upper limit of exercise intensity. In particular, the elderly and patients with chronic diseases should strictly avoid blindly following others and should not compete with each other in speed or strength.

The choice of a fitness environment is equally important for safety. Outdoor exercise is strictly prohibited on heavily polluted or smoggy days. During exercise, lung ventilation increases dramatically, and inhaled PM2.5 particles can directly damage the lungs and circulatory system. If smog persists for several days and the air quality is similar indoors and outdoors, indoor exercise should also be stopped. Fitness should be a regular lifestyle choice, not a short-term, intensive task. Through scientific exercise prescriptions and comprehensive risk management, obese individuals can truly achieve overall improvement in physical fitness while losing fat.